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On January 11, 2024, the United Kingdom (U.K.) Supreme Court rendered its judgment in Paul v Royal Wolverhampton NHS Trust, restricting the circumstances in which "secondary victims" can successfully claim for damages in clinical negligence cases. This ruling has provided welcome clarity regarding the scope of negligently caused "pure" psychiatric illness claims, but the judgment may well prove controversial. In this article, I trace the facts and opinion from the majority and also discuss an important dissenting opinion. I then reflect on what the ruling means for psychiatric illness claims by secondary victims, and more broadly on the implications for clinical negligence law. I suggest that while much-needed clarity has been injected in this area of the law, it is difficult, reading the majority of the Supreme Court's emphasis on the restricted scope of a medical practitioner's duty, to envision a scenario in which secondary victim could ever succeed in a clinical negligence context. [ABSTRACT FROM AUTHOR]

This article examines the United Kingdom Supreme Court decision in Whittington Hospital NHS Trust v XX [2020] UKSC 14. The case centred on whether damages could be awarded for the cost of a commercial surrogacy arrangement in California, following clinical negligence by the hospital that left the plaintiff unable to carry her own children. After examination of this case, the article outlines and compares the United Kingdom and Australian surrogacy laws. It then discusses how a similar case would be decided in Australia and argues that the result would be the same in some Australian States. It also discusses the concept of reproductive autonomy and the importance of this concept when considering cases involving the loss of fertility. [ABSTRACT FROM AUTHOR]

Clinical negligence claims for pressure injuries against the NHS continue to rise annually. This article will discuss the number of claims and financial costs to the NHS, together with the legal processes involved. Issues such as duty of care, breach of duty and harm and how these are interpreted in law will be explained, together with advice on how to avoid a potential negligence claim in the future. The author will discuss scenarios specific to primary care, such as non-adherence to pressure injury prevention strategies and how to manage these effectively. The importance of accurate, concise, relevant and factual documentation will also be discussed in detail. [ABSTRACT FROM AUTHOR]

Aim: To investigate the extent and impact of litigation on the UK physiotherapy profession., Design: An online cross-sectional questionnaire survey design was used. The survey was open to all qualified physiotherapists who have practiced in the UK, from any speciality, of any grade and from any setting including NHS, non-NHS, and private practice., Results: 688 respondents completed the survey (96% CI). All UK nations were represented. 73% were female, 44% were qualified >20 Years. Most worked in the NHS (74%) and worked in a neuromusculoskeletal setting (62%). 10% of respondents had been involved in litigation. 128 claims were reported with some respondents being involved in more than 1 case. Litigation was a highly stressful experience for those who experienced it and was a source of concern for many others. The personal impact was stress (76%) and worry and anxiety (67%). The most common professional impact was defensive practice (68%). Most respondents incorrectly identified who should provide their legal support. 46% were not satisfied with the support received. Most (77%) reported that litigation training should be included in pre-registration, as well as postgraduate (68%) programs., Conclusion: This is the first UK survey that has investigated the experiences of litigation on the UK physiotherapy profession. Ten percent of physiotherapists in our survey had been involved in litigation. Litigation impacted physiotherapists' physical and mental wellbeing and their clinical practice. Improved support, both emotional and legal is required. Clinical negligence training should be included in pre-registration and postgraduate programs. CONTRIBUTION OF THE PAPER., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Cauda equina syndrome (CES) is a condition where early identification and treatment is crucial to avoid potentially devastating effects. There is a high number of litigation cases linked with CES given it is a relatively rare condition. This scoping review protocol proposes to explore the extent and process of CES litigation in UK healthcare context cases amongst UK physiotherapists. Methods and analysis: The methodological framework recommended by Arksey and O'Malley, Levac et al. and the Joanna Briggs Institute will be used throughout this review to aid reporting and transparency. A patient and public involvement (PPI) group meeting was convened at the beginning of the review process in order to provide knowledge exchange to inform the search strategy and propose resources to be used during the scoping review. Two reviewers will independently review the literature in order to apply the inclusion and exclusion criteria. Once the studies to be included have been identified, the data from these studies will be extracted and charted. Results will show quantitative data of the studies included in the review and a narrative synthesis of the literature. Dissemination: This scoping review will evaluate the existing knowledge relating to CES and litigation and will map the key concepts around this topic. Results will be disseminated to practitioners and policy‐makers through peer‐reviewed publications, conferences, reports and social media. This method may prove helpful to others who are investigating extent and processes relating to medicolegal cases involving healthcare practitioners. Registration: The current paper is registered with OSF registries (DOI 10.17605/OSF.IO/MP6Y3). [ABSTRACT FROM AUTHOR]

Purpose: Groin hernia repair is the most frequently performed general surgical operation in the UK. Complications from laparoscopic and open repair are well recognised; however, potential differences are yet to be considered in relation to litigation. Methods: Administrative data were obtained and analysed from the NHS Litigation Authority for inguinal hernia-related claims from 1995 to 2016. Claims identified as using an open or laparoscopic approach were compared. Results: 880 claims were made, 760 had been settled. 88 laparoscopic and 241 open procedures were identified; 65% laparoscopic and 63% open hernia claims were found to be in favour of the claimant. Payouts totalled to 4.1GBP/4.8EUR/5.3USD million and 9.4GBP/11.0EUR/12.1USD million for laparoscopic (mean 82,824GBP/96,579EUR/106,453USD) and open (mean 66,796GBP/77,892EUR/85,852USD) approaches, respectively. The most common reasons for claim initiation were visceral/vascular injury (54%) in the laparoscopic group, and testicular complications or chronic pain (35%) in the open group. Additional procedures were necessary for 48% and 44% of laparoscopic and open claims, respectively. The highest average payouts were associated with visceral injury, (laparoscopic 116,482GBP/135,820EUR/149,715USD; open 199,103GBP/232,246EUR/255,905USD) and vascular injury (laparoscopic 88,624GBP/103,369EUR/113,892USD; open 64,460GBP/75,163EUR/82,870USD). Additional procedures resulted in an average payout of 93,352GBP/108,917EUR/120,008USD (laparoscopic) and 60,408GBP/70,506EUR/77,657USD (open). The most common additional procedures were corrective visceral/vascular repairs, orchidectomy and recurrent hernia repair. Conclusions: The rate of litigation for clinical negligence in inguinal hernia surgery in the UK is increasing. Whilst there has been a recent increase in laparoscopic hernia repair claims, the volume and burden of claims related to open procedures remain greater. [ABSTRACT FROM AUTHOR]

Williams v Bermuda Hospitals Board concerned questions of causation arising from a hospital board's negligent delay in failing to diagnose and treat a patient expeditiously. In this case, pus from a ruptured appendix began to develop before the hospital board's negligent delay in providing proper treatment by performing surgery to remove the appendix. This delay also contributed to the accumulation of sepsis, which eventually caused injury to the patient's heart and lungs. The purpose of the appeal was to determine whether it was possible in principle to substantiate a causal link by proving that a breach of duty of care made a material contribution to the damage suffered in cases where the factors contributing to the indivisible damage operated successively, as opposed to simultaneously. The Privy Council decided that Bonnington Castings v Wardlaw, the principal authority governing material contribution to damage, was not limited to cases in which the timing of the origin of the contributory causes is simultaneous. Whilst this makes Williams a patient-oriented decision, and commendable as a matter of principle, no indication is given as to whether there will be any difference in how damages are awarded in cases with multiple defendants versus cases with single defendant. Further, Williams' obiter comments on Bailey v Ministry of Defence and the relationship between the 'but for' test for and the material contribution test is vague, when a more definitive conclusion could have bolstered the pro-patient decision in this case. [ABSTRACT FROM AUTHOR]

This short article provides an overview of the legal system in the UK with a focus upon the civil law of negligence and its relevance for nursing practice. Further discussion is provided on the definition of negligence, duty of care, breach of duty and damage. Specific focus is given to the scope of nursing related to surgical dermatological nursing practice and the principle of vicarious liability. Duty of candour is also addressed. Some recommendations and suggestions on good practice are provided to assist in reducing the risk of exposure to claims of negligence. [ABSTRACT FROM AUTHOR]

English law around the sufficiency of the information provided to a patient as part of the consent process has evolved over time from being a decision for the clinician to make about what to disclose to one where the information must be bespoke to the individual patient about risks that would be material to them personally, but perhaps not necessarily to the next person. Failure to provide sufficient information for decision-making could result in a clinical negligence claim for ‘failure to warn’.The recent case of Montgomery versus Lanarkshire Health Board has significant implications for clinicians obtaining a patient's consent to treatment. The outcome of this case makes the planning of care truly patient-centred and puts the onus on the clinician to ascertain exactly what would be a material risk to that individual and ensure that they are given sufficient information on which to base an informed decision.This article discusses this step change in the legal requirements for the provision of information and how clinicians at The Christie, an English tertiary cancer centre, supported by our information services, have grasped this challenge of ensuring that patients are adequately informed about their treatment options.This article considers only competent adults being prepared for treatment. [ABSTRACT FROM AUTHOR]

The standard of care for consent to treatment has moved to the ‘prudent patient’ or ‘Montgomery’ standard, following the case of Montgomery v Lanarkshire (2015). The standard of care for treatment itself remains the ‘prudent practitioner’ or Bolam Standard following Bolam v Friern Hospital Management Committee (1957). What does this splitting of the legal standard of care for consent mean for the health professionals who deliver care to patients, and what does it mean for the quality of information patients now ought to expect to receive when they consent to treatment? This article considers the advent of true legal ‘informed consent’ into UK healthcare practice, and what it means for information provision to patients from an allied health professional medicolegal perspective. [ABSTRACT FROM AUTHOR]

This article arose from the back-to-back presentations by Michael Kelly and Patrice Métayer to the Anglo-French Medical Society in 2013 on the French and English legal systems handling a case of alleged clinical negligence as it proceeds from complaint to settlement or judgment in the two jurisdictions. Both systems have a hospital-based first stage with various avenues being available for amicable resolution, the French version being more regulated and prescribed than the English one. In both jurisdictions fewer than 5% cases go down the criminal route. Before the court is involved, in England there is an elaborate lawyer-controlled phase involving negotiations between the two sides and their experts which is expensive but often leads to pre-trial settlement for significant sums of money. Medical experts are central to all of this. In England they are largely unregulated and entirely advisory in an open market, in France they are both regulated and supervised by judges, being placed on official lists. These experts take a major inquisitorial role in a Debate between the two sides, combining the functions of Single Joint Expert (SJE), arbiter and mentor. If agreement is not reached, a second Debate before a different Expert is arranged. In both countries fewer than 5% cases reach a court for a hearing before a judge. In England a trial is an elaborate lengthy, expensive adversarial contest where all of the issues are rehearsed in full with factual and expert evidence, whereas in France in a contested case the judge reviews the reports of the two Debates with the lawyers who were involved (and not the experts, factual witnesses or parties). [ABSTRACT FROM AUTHOR]

The article examines the law surrounding causation in situations when a death could be said to have been accelerated with particular reference to the case of Davies v Countess of Chester Hospital [2014] EWHC 4294 (QB). In doing so, the authors will argue that there are two options available to the courts, one that is an arbitrary time limit and the second which focuses on materiality. [ABSTRACT FROM AUTHOR]

Abstract: The Department of Health is considering imposing a legal duty of candour on health care providers to ensure that an apology and explanation are given to patients when errors occur during medical treatment. This aims to improve quality of care and reduce adverse events during medical treatment. We present the current system of clinical negligence and the future of medical ethics. We discuss relevant cases with regard to duty of candour, and highlight the existence of serious imbalances in which patients’ rights and corresponding ethical duties of professionals predominate over the responsibilities of patients themselves. It is known that most adverse events arise because of multiple factors for which no individual should be blamed. To improve healthcare services there is a need for a system in which lessons can be learnt from mistakes, and services can be improved in the interest of patient safety, and for transparency in the broad principles on which the decisions are based within which clinical performance is supervised and monitored. [Copyright &y& Elsevier]

Abstract: Clinical negligence claims have been steadily increasing worldwide and these can pose a serious threat to the financial viability of healthcare organizations, threatening their very existence. They may also encourage ‘defensive’ practice, lack of transparency, avoidance of provision of ‘high risk’ services such as obstetrics and orthopaedics, to avoid potential clinical negligence claims. In the U.K., costs of clinical negligence claims have been steadily increasing. Hence, the NHS Litigation Authority (NHSLA) was established in 1995 as a Special Health Authority to administer an ‘insurance policy’ (called Clinical Negligence Scheme for Trusts or CNST) to participating trusts. The aim is to provide a scheme for NHS organizations to fund the cost of clinical negligence claims. Although the participation in this scheme is voluntary, currently all the trusts in England are enrolled in this scheme. As at 31 March 2008, the NHSLA estimates that it has potential liabilities of £12.1 billion, of which £11.9 billion relate to clinical negligence claims. [Copyright &y& Elsevier]

Clinical physiologists have a vital role to perform in the diagnosis and treatment of patients. They perform sensitive and invasive procedures such as assessments and adjustments of pacemakers, internal ultrasounds and endoscopies, and lung function tests. Despite the risky nature of their work, clinical physiologists fall outside the scope of statutory regulation and are currently only subject to regulation by a voluntary register held by the Registration Council for Clinical Physiologists. While the Registration Council for Clinical Physiologists strives to maintain a register which sets a high practicing standard and which can hold practitioners to account, the nature of voluntary registration means the Registration Council for Clinical Physiologists lacks the statutory power to ensure practitioners comply with the correct processes and requirements and has no authority to discipline clinicians who practice negligently. This means that incompetent practitioners remain practically unaccountable for their actions, leaving patients without much needed protection, and putting their safety at serious risk. Over the past decade, statutory regulation has been recommended on a number of separate occasions by experts including the Health and Care Professions Council, and yet today, the workforce still exists outside the umbrella of professional oversight and scrutiny. [ABSTRACT FROM AUTHOR]

A claim for clinical negligence arising out of a failure to diagnose appendicitis was assisted by the misunderstanding of the Defendant's expert of his role as an expert witness, NHS Direct call recordings allowing the judge to hear the pain in the Claimant's voice, and the inherent defects in the treating doctor's note. [ABSTRACT FROM AUTHOR]

Introduction: Cauda Equina Syndrome (CES) is a condition where early identification and treatment is crucial to avoid potentially life changing devastating effects. This paper reviews the extent and process of CES litigation amongst UK physiotherapists., Methods: A well-established framework by Arksey and O'Malley was followed when completing the current scoping review. Records were identified via a comprehensive search of three databases as well as website and grey literature searching. Data was extracted and a descriptive analysis and thematic summary were formed., Results and Discussion: A total of N = 1639 records were identified, following removal of duplicates and screening of titles and abstracts N = 211 full text records were screened and N = 39 were included for full analysis., Conclusions: This study is the first to investigate the extent and process of CES litigation for physiotherapists in the UK. Our data suggest that between 2009 and 2021 there were 15 CES claims recorded against physiotherapists which is 0.7% of all CES claims recorded in the UK. In terms of the legal process for CES claims, there is currently limited information for physiotherapists and what steps they would need to take once they receive notification they are being sued., Registration: The current paper is registered with OSF registries (DOI 10.17605/OSF.IO/6FCXN)., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The SARS-CoV-2 pandemic has highlighted discrepancies between surgeons' professional duties and legal protections when acting outside their specialities during the pandemic. These discrepancies between legal and professional standards leave surgeons and the NHS vulnerable to litigation. In the following article, we explore the liabilities that have arisen for surgeons during this period in the United Kingdom and Canada. We recommend, upon review of the literature, that a two-pronged approach be taken to address these discrepancies; (a) a change in policy at the national level to accurately reflect the constraints and demands placed upon the profession in this acute health crisis and (b) the provision of clearer, more stringent legal protection. In the interim, we suggest that individual surgeons utilise a decision-making framework where they consider their personal and professional obligations in regard to resource stewardship, innovation in practice, patient-specific contexts, and patient advocacy while acting outside of their speciality., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The defendant GP failed to refer the claimant patient to the early pregnancy unit for specialist care and/or a diagnostic scan despite knowing that the claimant was at a higher-than-average risk of having an ectopic pregnancy. The claimant subsequently suffered a rupture of an ectopic pregnancy and a life-threatening haemorrhage resulting in the claimant being unable to conceive naturally. [ABSTRACT FROM AUTHOR]

Clinical negligence claims are on the rise, with lawyers often playing a leading part in ascertaining what went wrong, why it went wrong and what lessons can be learned. I present a schema which may help lawyers better understand what goes wrong in clinical negligence cases.

We consider various types of litigation that may follow the Covid-19 pandemic, including: claims against National Health Service (NHS) Trusts by patients who have contracted the coronavirus (or by their bereaved families), claims by NHS staff against their employer for a failure to provide any or adequate personal protective equipment or testing, commercial claims arising from the procurement of medical supplies, the potential liabilities to those who suffer adverse reactions to any vaccine and the guidance issued by the regulators in relation to subsequent disciplinary action.

Negligent delay in the diagnosis and treatment of infected cervical discitis leading to a permanent and partial C5 tetraplegia.Settlement: 8 March 2012.Christopher Wilson-Smith QC and Caroline Hallissey of Outer Temple Chambers, instructed by Antonia Jones of Stewarts Law LLP for the claimant.Sarah Pritchard of Kings Chambers, instructed by Vanessa Splaine of Weightmans LLP for the defendant. [ABSTRACT FROM PUBLISHER]

The Francis Report made an achievable and sensible recommendation of a single regulator to ensure future quality of patient care. Anne Burge, Chair of the Alliance for Patient Safety, argues that it is high time the Government took forward this specific recommendation, while taking the opportunity to regulate currently unregulated healthcare professionals for the sake of patients’ safety. [ABSTRACT FROM AUTHOR]

The article discusses the settlement of a clinical negligence case filed by the claimant against the Guy's & Saint Thomas hospital National Health Service (NHS) foundation trust in Great Britain. The claimant alleged that she suffered chronic partial hypoxia due to cord compression during labour and claimed that there was a failure to deliver prior she sustained injury. Information on the condition and prognosis of the claimant is offered.